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~ _ ~ ~ <br />• 112 Attachment <br />Permittee Name: United Sand & Gravel Company RECEIVED <br />Operation Name: DeBEQUE PIT <br />Permit No: 81-58 NOVZ319A4 <br />Anniversary Date: Septemlher 7 MINEDUNDRECUMATIONOIVI910N <br />a. Debt. of N~tur~l Re~ourgs <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~~' Annual Report <br />~~Map <br />Remarks: <br />C <br />ignature <br />(Rev. 5184) <br />Doc. No. 1805 <br />